Healthcare Provider Details

I. General information

NPI: 1649001850
Provider Name (Legal Business Name): AIDS HEALTHCARE FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2024
Last Update Date: 08/09/2024
Certification Date: 08/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1709 E 53RD STREET
CHICAGO IL
60615
US

IV. Provider business mailing address

19300 S HAMILTON AVE STE 110-111
GARDENA CA
90248-4400
US

V. Phone/Fax

Practice location:
  • Phone: 773-241-5950
  • Fax:
Mailing address:
  • Phone: 310-771-0562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: KENNETH SCOTT CARRUTHERS
Title or Position: CHIEF OF PHARMACY
Credential:
Phone: 323-860-5200